Notice of Privacy Practices

Galena Aesthetics LLC

Effective date: [TO BE COMPLETED: effective date, e.g. November 1, 2026]

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations. We will say “yes” unless a law requires us to share it.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide it promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.

Be notified of a breach

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints (opens in a new tab). We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • share information with your family, close friends or others involved in your care;
  • share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

  • marketing purposes;
  • sale of your information;
  • most sharing of psychotherapy notes.

Our uses and disclosures

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you. Example: one of our providers reviews your treatment plan with another member of our clinical team.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use your information to schedule appointments and send appointment reminders.

Bill for your services

We can use and share your health information to bill and get payment from you, health plans, or financing companies you choose to use. Example: we give information about your treatment to a payment plan provider you have applied with.

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. We have to meet many conditions in the law before we can share your information for these purposes:

  • Public health and safety issues, such as preventing disease, reporting adverse reactions to medications or products, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
  • Research, under the conditions allowed by law.
  • Complying with the law, including sharing information with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
  • Organ and tissue donation requests, and working with a medical examiner or funeral director.
  • Workers’ compensation, law enforcement and other government requests, such as for workers’ compensation claims, law enforcement purposes or with a law enforcement official, health oversight agencies for activities authorized by law, and special government functions such as military, national security and presidential protective services.
  • Lawsuits and legal actions, in response to a court or administrative order, or in response to a subpoena.

Florida law may provide additional protection for certain types of health information. Where it does, we will follow the more protective law.

Our responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information, see the HHS page Notice of Privacy Practices for Protected Health Information (opens in a new tab).

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Contact us

For questions about this notice, to exercise any of your rights, or to file a complaint with us, contact our Privacy Officer:

[TO BE COMPLETED: Privacy Officer name and title]
Galena Aesthetics LLC
976 N Orange Ave Unit B, Winter Park, FL 32789
Email: concierge@galenaaesthetics.com
Phone: [TO BE COMPLETED: practice phone number]

See also our Website Privacy Policy, which explains how information is handled on this website.